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Topamax (topiramate) is an anticonvulsant medication predominantly used to help reduce the frequency and severity of seizures and migraine headaches. It may be used in patients as young as 2 years old for seizures; it is generally reserved for patients at least 12 years old with migraines.

In both cases it's common for Topamax may be used on its own or with other medications. Topamax must be taken daily over the long term to provide benefit.

Topamax is also used off-label in numerous other conditions, ranging from weight loss to alcoholism, and is being investigated for even more applications.

Managing Seizures with Topamax

In treating seizures, Topamax is typically used in:

  • Partial-onset seizures
  • Primary generalized tonic-clonic seizures
  • Seizures associated with Lennox-Gastaut syndrome

In partial-onset and primary generalized tonic-clonic seizures Topamax may be used on its own or along with other seizure medications. In Lennox-Gastaut syndrome other medications are nearly always taken along with Topamax. In no scenario should Topamax be used as a fast-acting "rescue" treatment; it is not a replacement for clonazepam, nitrazepam, or other fast-acting medications.

Topamax reduces the frequency and severity of seizures, and for many patients eliminates them completely. For maximum benefit and to reduce risk of side effects it is important the medication be taken consistently, every day and at the same times each day to keep levels of the drug consistent.

Dosage will depend on age, other medical conditions, other medications being taken, and other personal variables. In patients under 10 years old dosage will depend almost entirely on weight. A rough guideline for otherwise healthy patients ages 10 and up:

  • Treatment may start at low doses of 50 mg per day, gradually increased every two or three weeks.
  • The standard daily dose of Topamax when it is the only medication being taken is 400 mg per day, divided into two doses taken morning and evening.
  • When other anti-seizure medications are being taken the standard dose is 200 mg per day, divided into two smaller doses taken morning and evening. This can vary significantly, however, depending on the other medications involved.
  • Each dose should be taken with a full glass of water.
  • Tablets may be taken with or without food according to personal preference.

Some patients notice improvements (fewer or less severe seizures) just days after starting Topamax, but it should be taken for several weeks before evaluating results---it may take a month before significant results are seen. Maximum results should be seen within two months.

Treatment may continue for as long as Topamax continues to provide benefit. Treatment should not stop abruptly; speak with a doctor about a discontinuation plan.

Topamax for Migraines

Topamax sees wide use as a migraine treatment, and, though off-label uses, is sometimes taken for other types of headaches, such as tension headaches. There is also some evidence that Topamax reduces the frequency and severity of cluster headaches, though this is not currently an approved use and little clinical data is available.

As mentioned above, Topamax is a long-term treatment and not a fast-acting rescue treatment. Rescue treatments, such as triptan medications or painkillers, may still be utilized if a headache does occur.

Administration is simple:

  • The standard dose of Topamax for migraines is 100 mg per day, divided into two 50 mg doses taken morning and evening.
  • Each dose should be taken with a full glass of water.
  • Tablets may be taken with or without food according to personal preference.

Some patients notice improvements days after starting treatment, but more commonly it takes one or two months to see significant results. Maximum results should be seen after three months. If there is no noticeable improvement after two months of treatment, alternative options should be considered.

Treatment may continue for as long as Topamax continues to provide benefit.

Important Considerations

Topamax is known to be harmful to unborn babies. Women trying to conceive or who are sexually active but do not have access to reliable birth control should not take this medication. If pregnancy is discovered while taking Topamax, speak with a doctor as soon as possible. Keep in mind that if taking this medication for seizures, especially if it has been taken long term, treatment should not stop abruptly.

Topamax can increase risk of developing kidney stones, which is why taking each dose with a full glass of water is encouraged. Additional fluid intake will further ensure hydration and lower this risk.

Other medications can interact with Topamax, reducing effectiveness of one or more of the medications involved. This includes over-the-counter medications and supplements. Check with a doctor or pharmacist before taking any other medications while taking Topamax.


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Medicines have benefits and some have risks. Always read the label and use only as directed. If symptoms persist or you have side effects see your health professional.

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